“
“A woman, aged 50, was admitted to hospital with anemia. Ten years previously, she had been diagnosed with non-cirrhotic portal hypertension. Physical examination revealed pallor and an enlarged spleen, 6 cm below the left costal margin. Blood tests revealed a hemoglobin of 48 g/l (4.8 g/dL), a white cell count of 1.9 × 109/l, a platelet count of 35 × 109/l and a reticulocyte count of 4.4%. Renal and liver function tests were normal. Upper gastrointestinal endoscopy revealed small esophageal varices (Grade

I). An upper abdominal ultrasound study showed an enlarged spleen, marked dilatation of the splenic vein (5 cm) in the splenic hilum and other features of portal hypertension. A contrast-enhanced computed tomography (CT) scan showed a large aneurysm arising from the splenic vein that measured 63 × 53 mm in size (Figures 1 and 2). The patient was managed Rucaparib concentration by excision of the aneurysm and splenectomy. Aneurysms of the splanchnic veins are rare. Approximately 50% of these aneurysms arise from the portal vein and 30% from the splenic vein. Predisposing factors include portal hypertension, pancreatitis and congenital

weakness of the venous wall. Most of the aneurysms are asymptomatic and have been detected on imaging studies. However, there are case reports where aneurysms have become symptomatic because of thrombosis or bleeding. Asymptomatic aneurysms have mostly been observed without surgery. However, in the patient described above,

splenectomy was performed Estrogen antagonist because of typical features of hypersplenism 上海皓元 as well as concerns about the size of the aneurysm and the risk of bleeding in the presence of thrombocytopenia. However, there are insufficient cases in the medical literature to determine whether aneurysms associated with portal hypertension or coagulopathy are more likely to be complicated by bleeding than aneurysms that occur in the absence of portal hypertension or coagulopathy. Only rare patients with cirrhosis or non-cirrhotic portal hypertension have a splenectomy for hypersplenism. However, when splenectomy is performed, there is usually a rapid improvement in anemia, neutropenia and thrombocytopenia and at least some reduction in portal pressure. In the longer-term, some patients with cirrhosis may have persistent thrombocytopenia because of impaired synthesis of thrombopoietin. Contributed by “
“The conclusion of the article by Vitale et al. that a Markov decision analysis suggests that sorafenib neoadjuvant therapy is cost-effective and supports the need for clinical trials deserves several comments and must be challenged.1 Markov decision processes model problems of sequential decision-making. However, here, the tested hypotheses are characterized by lack of evidence or uncertainty: The modest effectiveness of sorafenib is only documented for treating patients with advanced hepatocellular carcinoma (HCC) for whom surgical or locoregional therapies had failed or were not suitable.